Anticoagulation, Preoperative

Risk

• Pts with mechanical heart valves, atrial fibrillation, pulm embolism, or recent venous thrombosis.

• Oral anticoagulant therapy (warfarin, oral Xa inhibitor-rivaroxaban, apixaban, and edoxaban) and direct thrombin inhibitor (dabigatran) and use of low-molecular-weight heparin, fondaparinux may increase potential risks in elective or emergency surgery.

• Other populations include pts who receive heparin IV before vascular or cardiac surgery and pts undergoing cardiac surgery with extracorporeal circulation.

Perioperative Risks

• Balance between risk of bleeding versus thromboembolic complication is a major periop risk.

• Risk is greater with major and emergency versus elective surgery.

Worry About

• Excessive allogeneic transfusions, either to correct effects of anticoagulation or for risk of excessive bleeding.

• In pts with valvular heart disease, concomitant hepatic dysfunction due to HF may produce abnormal PT and/or thrombocytopenia.

• Heparin-induced thrombocytopenia can be associated with heparin therapy due to acute administration or prolonged use (∼5 d).

Overview